RE: Re: help naming service and motivation

[Guest guest]

Thanks! That is great. Must wonder if rules vary from state to state,

but I love having such a precedent there.Tim > > > > Here is what some of us

are doing in Rhode Island, and it seems to be> working well...>

> http://www.healthaccessri.com/> > The program has been

legally reviewed; by billing patients at the end> of the month (not the

start), we are not acting as insurance companies.> > >

------------------------------------> >

[Guest guest]

In some Hispanic Cultures (Puerto Rico) patos can also be homosexuals!-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

The whole concept of avoiding being considered an insurance

company is somewhat untested legally. It is only a issue if your

recurring fee covers medical services. If you are charging only for

non-medical services (like access, email, whatever) and charging separately for

visits, it is a different issue.

A few guidelines to help:

1.

Bill “in arrears” as states.

Charging the monthly or quarterly fee after the fact is important in a legal

sense. If you don’t want to see people you don’t know without

a charge the first time, you can charge an enrollment or registration fee that

may be equal to the monthly fee but payable up front, and then start the

recurring monthly charge at the end of the first month.

2.

Limit your services. Offering unlimited visits could be

construed as insurance. So, limit to 12 or 24 or 365 visits a year, but

clearly state a limit. You could end up not charging if someone goes over

this limit (like a patient of mine did who was essentially a hospice patient I

did a home visit on everyday), but you need to be able to charge for visits

over your limit.

3.

State that you or the patient can terminate the contract for any

reason with a certain notice. Again, insurance can’t do this.

I’m sure there are others I’m not thinking of right

now.

If you charge a recurring fee, consider using a credit card

service that does automatic recurring transactions. I resisted this due

to the fees, but boy is it worth it to not have to chaise done checks every

month. I use Quickbooks Merchant Services and it is very handy for this,

quite easy to set up, and fees are same or lower than other ways to accept

credit cards. Many of my patients use this for Visa or Mastercard Health

Care Reimbursement Cards. I can email receipts very easily from within

Quickbooks.

Sharon

Sharon McCoy , MD

Renaissance Family Medicine

10 McClintock Court, Irvine, CA 92617

Phone: ; Fax:

Email: SharonMD@...

website: www.SharonMD.com

From:

[mailto: ] On Behalf Of

Malia, MD

Sent: Saturday, January 10, 2009 2:12 PM

To: lisa_r_denny@...; practiceimprovement1

Subject: Re: Re: help naming service and

motivation

Thanks! That is great.

Must wonder if rules vary from state to state, but I love having such a

precedent there.

Tim

>

>

>

> Here is what some of us are doing in Rhode Island, and it seems to be

> working well...

>

> http://www.healthaccessri.com/

>

> The program has been legally reviewed; by billing patients at the end

> of the month (not the start), we are not acting as insurance companies.

>

>

> ------------------------------------

>

>

[Guest guest]

Pedro, thank you!My wife is Bolivian, so we thought of ducks, the formal

meaning. But I didn't know about the Puerto Rican slang use of the word.As PR

is the largest latino community in the area, and I have some in the practice, I

think I'll slightly change the term .... hmmm, perhaps " Pay On Day Seen "

or P.O.D.S. What do folks think of that? Any problem with it, or slang

terms that might make some people uncomfortable?TimOn Sat, January 10, 2009 5:29 pm EST, Pedro

Ballester wrote:

In some Hispanic Cultures (Puerto Rico)

patos can also be homosexuals!-- Pedro Ballester,

M.D.Warren, OH

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

[Guest guest]

Thank you. Great thoughts and advise.Yes, I was thinking

that " new " patients may be asked to pay as if they are PODS (pay on day

seen) before becoming Direct Pay patients. Patients I've already worked with

could sign on as Direct Pay which I think I'll offer as quarterly/semiannual/annual

options with payments at the end of the period. And, yes, I was also planning

to require the credit card info to be left.Would anyone be willing to

forward to me a " contract " or agreement you use for these matters?I'm just wondering about wording for legal issues with the patients. What if

you try to bill someone, card doesn't work, you contact them and they say, " oh,

I forgot to tell you that I want to switch to PODS " or perhaps, " oh, I've

switched my primary care doctor a few months ago, so these past 3 months you weren't

my physician, " etc. Any thoughts on this kind of nitty-gritty would be

appreciated.Tim On Sat, January

10, 2009 7:07 pm EST, Sharon wrote:

The whole concept of avoiding being

considered an insurancecompany is somewhat untested legally. It is only a

issue if yourrecurring fee covers medical services. If you are charging only

fornon-medical services (like access, email, whatever) and charging separately

forvisits, it is a different issue.

A few guidelines to help:

1. Bill “in arrears” as

states. Charging the monthly or quarterly fee after the fact is important in a

legalsense. If you don’t want to see people you don’t know

withouta charge the first time, you can charge an enrollment or registration

fee thatmay be equal to the monthly fee but payable up front, and then start

therecurring monthly charge at the end of the first month.

2. Limit your services. Offering

unlimited visits could beconstrued as insurance. So, limit to 12 or 24 or 365

visits a year, butclearly state a limit. You could end up not charging if

someone goes overthis limit (like a patient of mine did who was essentially a

hospice patient Idid a home visit on everyday), but you need to be able to

charge for visitsover your limit.

3. State that you or the patient can

terminate the contract for anyreason with a certain notice. Again, insurance

can’t do this.

I’m sure there are others

I’m not thinking of rightnow.

If you charge a recurring fee, consider

using a credit cardservice that does automatic recurring transactions. I

resisted this dueto the fees, but boy is it worth it to not have to chaise

done checks everymonth. I use Quickbooks Merchant Services and it is very

handy for this,quite easy to set up, and fees are same or lower than other

ways to acceptcredit cards. Many of my patients use this for Visa or

Mastercard HealthCare Reimbursement Cards. I can email receipts very easily

from withinQuickbooks.

Sharon

Sharon McCoy , MD

Renaissance Family Medicine

10 McClintock Court, Irvine, CA 92617

Phone: ; Fax:

Email: SharonMD@...

website: www.SharonMD.com

From: [mailto: ] On Behalf Of

Malia, MDSent: Saturday, January 10,

2009 2:12 PMTo: lisa_r_denny@...;

practiceimprovement1 Subject: Re:

Re: help naming service andmotivation

Thanks! That is great. Must wonder if rules vary from state to state, but

I love having such aprecedent there.Tim> On

Sat, January 10, 2009 2:09 pm EST, lisa_r_denny wrote:> > > Here is what some of us are doing in Rhode Island, and it seems to be> working well...> > http://www.healthaccessri.com/>

> The program has been legally reviewed; by billing patients at the end> of the month (not the start), we are not acting as insurance companies.> > > ------------------------------------> >

[Guest guest]

Hi Tim,

Somehow, being referred to as a “POD”

doesn’t sound very appealing to me. One of the clinics that Steve

did moonlighting at has a “VIP” program for uninsured

patients. You can see what they offer at www.marinermedical.com and look at

their VIP Program.

I don’t have any type of contract –

I would imagine that the laws vary from state to state. But you might

want to put on your enrollment form that they need to notify you with 30 days

notice if they change PCPs, want to change plans, etc.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

Roy Medical Associates, Inc.

From:

[mailto: ] On

Behalf Of Malia, MD

Sent: Sunday, January 11, 2009

6:13 AM

To: docsharon@...;

practiceimprovement1

Subject: RE:

Re: help naming service and motivation

Thank you. Great thoughts and advise.

Yes, I was thinking that " new " patients may be asked to pay as if

they are PODS (pay on day seen) before becoming Direct Pay patients.

Patients I've already worked with could sign on as Direct Pay which I think

I'll offer as quarterly/semiannual/annual options with payments at the end

of the period. And, yes, I was also planning to require the credit card

info to be left.

Would anyone be willing to forward to me a " contract " or agreement

you use for these matters?

I'm just wondering about wording for legal issues with the patients. What

if you try to bill someone, card doesn't work, you contact them and they say,

" oh, I forgot to tell you that I want to switch to PODS " or perhaps,

" oh, I've switched my primary care doctor a few months ago, so these past

3 months you weren't my physician, " etc. Any thoughts on this kind

of nitty-gritty would be appreciated.

Tim

On Sat, January 10, 2009 7:07 pm EST, Sharon

wrote:

The whole concept of avoiding being considered an insurance

company is somewhat untested legally. It is only a issue if your

recurring fee covers medical services. If you are charging only for

non-medical services (like access, email, whatever) and charging separately for

visits, it is a different issue.

A few guidelines to help:

1.

Bill

“in arrears” as states.

Charging the monthly or quarterly fee after the fact is important in a legal

sense. If you don’t want to see people you don’t know without

a charge the first time, you can charge an enrollment or registration fee that

may be equal to the monthly fee but payable up front, and then start the

recurring monthly charge at the end of the first month.

2.

Limit

your services. Offering unlimited visits could be

construed as insurance. So, limit to 12 or 24 or 365 visits a year, but

clearly state a limit. You could end up not charging if someone goes over

this limit (like a patient of mine did who was essentially a hospice patient I

did a home visit on everyday), but you need to be able to charge for visits

over your limit.

3.

State

that you or the patient can terminate the contract for any

reason with a certain notice. Again, insurance can’t do this.

I’m sure there are others I’m not thinking of right

now.

If you charge a recurring fee, consider using a credit card

service that does automatic recurring transactions. I resisted this due

to the fees, but boy is it worth it to not have to chaise done checks every

month. I use Quickbooks Merchant Services and it is very handy for this,

quite easy to set up, and fees are same or lower than other ways to accept

credit cards. Many of my patients use this for Visa or Mastercard Health

Care Reimbursement Cards. I can email receipts very easily from within

Quickbooks.

Sharon

Sharon McCoy , MD

Renaissance Family

Medicine

10

McClintock Court,

Irvine, CA 92617

Phone: ;

Fax:

Email:

SharonMD

website:

www.SharonMD.com

From:

[mailto: ] On Behalf Of

Malia, MD

Sent: Saturday,

January 10, 2009 2:12 PM

To: lisa_r_denny;

practiceimprovement1

Subject: Re:

Re: help naming service and

motivation

Thanks! That is great.

Must wonder if rules vary from state to state, but I love having such a

precedent there.

Tim

>

>

>

> Here is what some of us are doing in Rhode Island, and it seems to be

> working well...

>

> http://www.healthaccessri.com/

>

> The program has been legally reviewed; by billing patients at the end

> of the month (not the start), we are not acting as insurance companies.

>

>

> ------------------------------------

>

>

[Guest guest]

I understand the "billing in arrears" idea - monthly or quarterly after services are given.  But I'm having trouble understanding why it is then still OK to pay the whole annual fee up front?  Sharon, ?  You both have this option..-jessThe whole concept of avoiding being considered an insurance company is somewhat untested legally.  It is only a issue if your recurring fee covers medical services.  If you are charging only for non-medical services (like access, email, whatever) and charging separately for visits, it is a different issue.  A few guidelines to help: 1.        Bill “in arrears” as states.  Charging the monthly or quarterly fee after the fact is important in a legal sense.  If you don’t want to see people you don’t know without a charge the first time, you can charge an enrollment or registration fee that may be equal to the monthly fee but payable up front, and then start the recurring monthly charge at the end of the first month.2.       Limit your services.  Offering unlimited visits could be construed as insurance.  So, limit to 12 or 24 or 365 visits a year, but clearly state a limit.  You could end up not charging if someone goes over this limit (like a patient of mine did who was essentially a hospice patient I did a home visit on everyday), but you need to be able to charge for visits over your limit.3.       State that you or the patient can terminate the contract for any reason with a certain notice.  Again, insurance can’t do this. I’m sure there are others I’m not thinking of right now. If you charge a recurring fee, consider using a credit card service that does automatic recurring transactions.  I resisted this due to the fees, but boy is it worth it to not have to chaise done checks every month.  I use Quickbooks Merchant Services and it is very handy for this, quite easy to set up, and fees are same or lower than other ways to accept credit cards.  Many of my patients use this for Visa or Mastercard Health Care Reimbursement Cards.  I can email receipts very easily from within Quickbooks. Sharon Sharon McCoy , MD Renaissance Family Medicine10 McClintock Court, Irvine, CA  92617Phone:  ;  Fax:  Email:  SharonMDwebsite:  www.SharonMD.com     From:  [mailto: ] On Behalf Of  Malia, MDSent: Saturday, January 10, 2009 2:12 PMTo: lisa_r_denny; practiceimprovement1 Subject: Re: Re: help naming service and motivation Thanks!  That is great. Must wonder if rules vary from state to state, but I love having such a precedent there.Tim> > > > Here is what some of us are doing in Rhode Island, and it seems to be> working well...> > http://www.healthaccessri.com/> > The program has been legally reviewed; by billing patients at the end> of the month (not the start), we are not acting as insurance companies.> > > ------------------------------------> >